Operating Room and Door-Opening Control Strategies to Reduce Intraoperative Microbial Contamination: A Systematic Review

Abstract

Background

Microbial contamination of operating room air is a modifiable contributor to surgical site infection risk. Door-opening behaviour and staff traffic are thought to disrupt pressure and airflow, yet the impact of specific door-opening control strategies on intraoperative contamination has remained uncertain.
Methods

A systematic review of PubMed, Scopus and Web of Science was conducted from inception to May 2025. Clinical trials, quasi-experimental studies and observational cohorts in human operating rooms were eligible if they quantified intraoperative airborne microbial or particle contamination in relation to door-opening frequency or a defined door-opening control strategy. Primary outcomes were intraoperative airborne microbial load (colony-forming units per cubic metre) and particle counts; secondary outcomes included door-opening rate and surgical site infection incidence.
Results

Ten studies were included across observational cohorts, higher door-opening rates and greater numbers of personnel were consistently associated with increased airborne contamination; one study reported mean 328 CFU/m³ with 84% of samples above 180 CFU/m³ in high-traffic theatres, and another found traffic flow explained 68% of CFU variance. Interventions such as access signage, staff education and multimodal quality-improvement programmes reduced door-opening rates by about 20-40% and lowered particle counts in the sterile field by up to 40%.
Conclusions

Door-opening frequency and operating room traffic are consistently associated with higher intraoperative airborne contamination, and simple door-control strategies can meaningfully reduce traffic and environmental bioburden; their independent effect on surgical site infections remains uncertain and warrants robust prospective evaluation.